From the Guidelines
Lidocaine is used as a pretreatment agent in Rapid Sequence Intubation (RSI) to blunt the sympathetic response to laryngoscopy and intubation, particularly in patients with increased intracranial pressure (ICP) or cardiovascular disease, with a typical dose of 1.5 mg/kg IV given 2-3 minutes before intubation, as supported by the most recent guidelines 1. The purpose of lidocaine in RSI is to suppress cough reflexes, attenuate the rise in ICP, and reduce the hemodynamic response (tachycardia and hypertension) that occurs during airway manipulation. This is especially beneficial in patients with head injuries, intracranial hemorrhage, or ischemic heart disease where sudden increases in blood pressure or heart rate could be detrimental. Some key points to consider when using lidocaine in RSI include:
- The potential benefits of lidocaine in reducing the risk of aspiration and optimizing intubating conditions, as outlined in the guidelines for RSI in critically ill adult patients 1
- The importance of careful patient selection and dosing to minimize the risk of adverse effects, such as hypotension, cardiac arrhythmias, and CNS toxicity at higher doses
- The need for ongoing monitoring and assessment of the patient's response to lidocaine and other medications used in RSI, as emphasized in the guidelines 1
- The potential for lidocaine to have mild bronchodilatory effects, which may be helpful in patients with reactive airway disease, as noted in the guidelines 1 It is essential to weigh the potential benefits and risks of using lidocaine in RSI and to consider alternative medications and strategies, as outlined in the guidelines 1. Ultimately, the decision to use lidocaine in RSI should be based on a careful assessment of the individual patient's needs and circumstances, and should be guided by the most recent and highest-quality evidence available 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Purpose of Lidocaine in Rapid Sequence Intubation (RSI)
The purpose of lidocaine in RSI is to:
- Blunt the cardiovascular response associated with intubation, such as elevated blood pressure and pulse, cough reflexes, and dysrhythmias 2
- Suppress coughing during tracheal intubation, with a dose of 1 mg/kg or more of intravenous lidocaine being effective 3
- Minimize pressure surges implicated in secondary brain injury in patients with presumed intracranial pathology 4
- Act as a premedication to facilitate smoother intubation and reduce complications 5, 6
Key Findings
- Lidocaine has been shown to be effective in blunting rises in pulse, blood pressure, intracranial, and intraocular pressure 2
- The optimal dose of prophylactic lidocaine is 1.5 mg/kg given intravenously 3 minutes before intubation 2
- Lidocaine can be given endotracheally in a 5-6 mg/kg dose diluted in 6 cc for suctioning of intubated patients 2
- The use of lidocaine and fentanyl as neuroprotective agents in RSI is underutilized, despite their potential benefits 4